Wiki Sumber Informasi iSIKHNAS

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==Important Disease Investigation and Response ==

===Introduction===
iSIKHNAS handles both routine and priority disease reports (U and P) from the field. These are usually initiated by Pelsa (village reporters) or paravets doing routine case work.  When a vet or paravet responds to a pelsa report they usually contact the pelsa to find out more about the case, visit if it seems important and respond to the system with a response report (R). The response report asks for a differential diagnosis from the attending staff member and it is here that a case is usually properly determined to be either important or routine.  Routine case management might involve treatments, lab samples and an outcome report, for example.  Important cases however require fuller investigation, may reach a definitive diagnosis and may require an outbreak response.

iSIKHNAS is able to be used for all the common activities involved in ''both'' routine cases as well as any field investigation of an important disease.  

An '''important disease''' is;
* a disease on the national priority list, 
* a disease with high mortality or morbidity, 
* a disease with zoonotic involvement, 
* a disease with unusual signs, or suspected of being a new or emerging disease.

The purpose of an investigation into an important disease is to determine a definitive diagnosis so that important diseases can be ruled in or out and so that our response to the disease event can be properly guided.  Before the diagnosis, information is required to determine if a response is urgent (not waiting for  diagnosis) and to gather information to help with designing a suitable response (assess the magnitude of the problem, and determine the epidemiology of the problem).

===Tools for use during an important disease investigation and response===

Disease investigation for important diseases can be complex and stressful.  iSIKHNAS works in partnership with veterinary staff to ensure good communication, ease the reporting burden, provide outside assistance when necessary and streamline the investigation process.  Disease investigation is greatly assisted by the use of worksheets (see above) which guide the investigation and response process and assist veterinary staff in the collection and reporting of investigation related data directly from the field.
 
* Formulir 1 & 2 are generic iSIKHNAS work guides to assist in any investigation and response for '''any disease''' including HPAI and Rabies.  

These worksheets are intended as a notetaking tool, a place for calculations and as a procedural guide only - they are not intended to be kept as a permanent record nor are they intended as rules for conducting investigations and response.  Data submitted via SMS to iSIKHNAS at every step of the investigation is linked to a case ID, incorporated into the database and immediately available for viewing, use and analysis by a wide range of users.  No further data entry is required.

[[Media:Formulir 1 - investigasi.docx|Formulir 1 - Investigasi]]

[[Media:Formulir 2 - respon v6.docx|Formulir 2 - Response]]

For information about the future integration of PDSR activities: [[PDSR Integration|PDSR Integration]]

==Investigation==

===What data should be collected during an important disease investigation?===
*Population
**How many animals in the village?
**How many affected (sick, dead, slaughtered, at risk)?
*What do they look like?
**Clinical signs
*Risk factors
**Have the sick animals been vaccinated for any diseases (helps with the differential)?
*Is it zoonotic?
**Human involvement
*Where did it come from?
**Source of the infection to take action there as well
*Tests
**Rapid test results or details of samples sent to the lab
*Diagnosis
**Definitive diagnosis (from field observations with or without evidence from tests)
*Monitoring and resolution
**Are control activities working? Is the problem continuing or resolved?

iSIKHNAS is able to collect, validate and manage all this information as it is being reported from the field, communicate it to others responsible and even get feedback from experts with access to the same data.  iSIKHNAS was designed with a certain philosophy which believes that;

* Important disease investigations and response should be a normal responsibility for all dinas veterinarians
* Any vet trained in the basic use of iSIKHNAS SMS reporting should be able to report the results of an investigation and response
* Investigations  and response reporting use the same tools (SMS messages) as used for routine case management, so users are familiar with them, even if important disease events are uncommon.

iSIKHNAS is also founded on the principle that all data capture tasks should provide much more benefit than costs to the user in the field. The important disease investigation service provided by iSIKHNAS eliminates paperwork, sends immediate notification to others that need to know and provides the opportunity for others to provide real-time support and expertise.  The transparency of the process also builds confidence in the entire system at every level.

====How iSIKHNAS collects this data====

{| class="wikitable"
|-
! Data collected in an investigation !! iSIKHNAS SMS code
|-
| '''Population''' 
|-
| How many animals in the village? || POP
|-
| How many affected (sick, dead, slaughtered, at risk)? || LTL
|-
| Clinical signs || TK
|-
| '''Risk factors'''
|-
| Have the sick animals been vaccinated for any diseases (helps with the differential)? || RVAK
|-
| Human involvement? || Z
|-
| Where did it come from? || SP
|-
| Recent livestock movements? || LAPSK
|-
| '''Tests'''
|-
| Rapid test results || UC
|-
| Samples sent to the lab || LAB
|-
| '''Diagnosis'''
|-
| Differential diagnosis || R
|-
| Definitive diagnosis (from field observations with or without evidence from tests) || DX
|-
| '''Monitoring and resolution '''
|-
| Are control activities working? Is the problem continuing or resolved? || LTL
|}

====Summary: Messages recommended for use in an important disease investigation====
* [[Operational instructions:LTL|LTL: Follow-up report/Laporan Tindakan Langjut]]
* [[Operational instructions:TK|TK: Clinical signs/Tanda Klinis]]
* [[Operational instructions:RVAK|RVAKː Vaccination/Riwayat Vaksinasi]]
* [[Operational instructions:Z|Zː Zoonosis]]
* [[Operational instructions:SP|SPː Source of disease/Sumbar Penyakit]]
* [[Operational instructions:UC|UC: Quick test results/Uji Cepat]]
* [[Operational instructions:LAB|LAB: Laboratory sample submission/Pengajuan Sampel ke Laboratorium]]
* [[Operational instructions:DX|DX: Definitive diagnosis/Diagnosa Definitif]]
* [[Operational instructions:R|R: Response/Respons]]





===Formulir 1 - Investigasi Penyakit Hewan Penting===

[[File:PDI_Form_1_.png|100px|thumb|left]]

This form is for use as a guide for a Dr Hewan during a field investigation of an important disease:  (a disease on the national priority list, a disease with high mortality or morbidity, zoonotic involvement, unusual signs, or suspected of being a new or emerging disease). All data should be submitted immediately as it is collected by SMS to iSIKHNAS using the formats described in this form. This form should be used as a worksheet to help SMS submission – do not submit this form.

In order to conduct a priority disease investigation, staff will need to be sure of the case ID and the location code of the locale where the case is situated '''prior''' to going to the field for the investigation.  All SMS messages sent during any priority disease investigation will require the case ID which is automatically created by iSIKHNAS as soon as a U or a P disease report is sent from the field.

Note these down on the form to help you because you may need them for several messages connected with this investigation.

[[File:PDI_form_id_kasus_dan_kode_lokasi 2.svg|800px|centre]]

'''ID Kasus''': This was included in the original alert report from the Pelsa or paravet. If you don't know it, you can find it by using laporan desa
{{#apGetSMSFormat:lapd|1}}  

'''Kode Lokasi''': To find the kode desa, use cari kode lokasi
{{#apGetSMSFormat:ckl|1}}

===Hewan Yang Terkena===

[[File:PDI_form_1_Hewan_yang_terkena.png|800px|centre]]

Count the total number of animals in the village/farm, and the number of affected animals.

[[File:PDI_form_1_Hewan_yang_terkena 2.svg|800px|centre]]

Report your findings of the affected animals (dead, sick, slaughtered and at risk) by SMS.

Format SMS : Pakai '''Laporan tindak lanjut''':

 {{#apGetSMSFormat:ltl|1}}

In the above example, the SMS would look like this...

 LTL 14667 sp 8 3 0 38 kr 0 0 0 15

'''Kode spesies''': You can get a list of species codes by sending 
 KODE SP

Report total populations by SMS

Format SMS '''Populasi''': 

 {{#apGetSMSFormat:pop|1}}

In this example, the simplest SMS report of your recent population count would look like this...

 POP sp 51 kr 15 73060306

To be more thorough, you should differentiate the animal types within species by using the more detailed codes for animal types used in population reporting.

'''Jenis hewan:''' Same as '''kode spesies'''. For more detail, look up codes using 
 KODE POP

Remember: Look at the top of the page where you should have written ''Kode lokasi'' or look up codes using 
{{#apGetSMSFormat:ckl|1}}

===Tanda Klinis===

Examine affected animals and report all the clinical signs.

[[File:PDI_FORM_1_Tanda_klinis.png|800px|centre]]

Format SMS '''Tanda Klinis''':

 {{#apGetSMSFormat:tk|1}}

'''Kode tanda''': To find the kode tanda use cari kode tanda 
{{#apGetSMSFormat:ckt|1}}]

===Riwayat Vaksinasi===

Ask the owner for the approximate date when the animals were last vaccinated for any relevant diseases. If yes:

[[File:PDI_form_1_riwayat_vaksinasi.png|800px|centre]]

Format SMS '''Riwayat Vaksinasi''':

 {{#apGetSMSFormat:rvak|1}}

'''Kode penyakit''': untuk mendapatkan kode tanda, gunakan cari kode penyakit 
{{#apGetSMSFormat:ckp|1}}

===Penyakit manusia ===

Ask if there are any people that have been exposed, are sick, or have died of a disease that may be related to the animal disease (a possible zoonotic disease).

[[File:PDI_form_1_penularan_pada_manusia.png|800px|centre]]

Format SMS '''Suspek Zoonosis''':

 {{#apGetSMSFormat:z|1}}

If there is no signs of human involvement or exposure send: 

  Z [ID kasus] 0 0 0

===Sumber penyakit===

Attempt to identify the origin of the disease by identifying the index case. If the suspected source is known:

[[File:PDI_form_1_sumber_penyakit.png|800px|centre]]

Format SMS '''Sumber penyakit''':

 {{#apGetSMSFormat:sp|1}}

You can check movement records using the '''laporan SKKH'''
{{#apGetSMSFormat:lapsk|1}}

You can find the kode sumber using 
 KODE SUM

If the disease appears to have come from another known location, enter the location code (optional).

=== Uji diagnostic===

[[File:PDI_form_1_uji_diagnostic.png|800px|centre]]

====Uji cepat====

Apakah tersedia uji cepat yang cocok? Jika Ya: 

Format SMS '''Uji cepat''':

 {{#apGetSMSFormat:uc|1}}

'''Kode uji''': to find the codes use
 KODE UC

Even if a rapid test is available, you should send samples to the laboratory for confirmation

You will also need to fill in a laboratory submission form to send to the lab with the sample.

====Laboratory submission====
Is it possible to collect suitable samples for laboratory diagnosis? (Phone the lab to check the right samples)

Format SMS '''Submisi laboratorium''':

 {{#apGetSMSFormat:lab|1}}

'''Jenis spesimen''': use 
 KODE JS

'''Bentuk specimen''': use 
 KODE BS

'''Seksi laboratorium''': use 
 KODE SE

'''Lab ID''': use cari kode infrastruktur 
{{#apGetSMSFormat:cki|1}}

===Laboratory submission===

Is it possible to collect suitable samples for laboratory diagnosis? (Phone the lab to check the right samples)

Format SMS '''Submisi laboratorium''':

 {{#apGetSMSFormat:lab|1}}

'''Jenis spesimen''': use
 KODE JS

'''Bentuk specimen''': use 
 KODE BS

'''Seksi laboratorium''': use 
 KODE SE

'''Lab ID''': use cari kode infrastruktur 
{{#apGetSMSFormat:cki|1}}

===Diagnosa===

[[File:PDI_form_1_diagnosa.png|800px|centre]]

Are you able to make a '''definitive diagnosis''' in the field? 

If yes:

Format SMS '''Diagnosa definitif''':

 {{#apGetSMSFormat:dx|1}}

'''Kode penyakit''': use cari kode penyakit
{{#apGetSMSFormat:ckp|1}}

If No, have you been able to refine the '''differential diagnosis''' made previously? If yes: 

Format SMS - Pakai '''Laporan Respons''':

 {{#apGetSMSFormat:r|1}}

'''Kode penyakit''': use cari kode penyakit
{{#apGetSMSFormat:ckp|1}}

====High priority diseases====

Does the diagnosis or differential diagnosis include:

* Rabies? - Complete the special information for rabies investigations

* Flu burung? - Complete the special information for HPAI investigations

===Tindak lanjut===

Make a follow-up visit to assess control measures at least once per week. If there is any new information at the follow-up visits, send the relevant SMS message.

Is the disease continuing? 

If Yes:

record the animals affected:

[[File:PDI_form_1_tindak_lanjut.png|800px|centre]]

Format SMS '''Laporan tindak lanjut''':

 {{#apGetSMSFormat:ltl|1}}

If No: 

the outbreak is resolved and no further follow-up visits are required. Send a final LTL message adding the final "Y" to indicate that the outbreak is resolved:

Format SMS '''Laporan tindak lanjut''':

 {{#apGetSMSFormat:ltl|1}}

[[File:PDI_form_1_status_penyakit.png|800px|centre]]

==Response==
===What data should be collected during a response to an important disease?===
Activities involved in responding to an important disease will differ widely depending on location, spread, urgency, strategies for control and many other factors. 

* Treatments
* Culling of livestock
* Vaccination activities
* Active surveillance activities
* Extension activities

====How iSIKHNAS collects this data====

{| class="wikitable"
|-
! Data generated in a response !! iSIKHNAS SMS code
|-
| Treatments || OB
|-
| Culling of livestock || CUL
|-
| Vaccination activities || VAK
|-
| Field surveillance || SLAP
|-
| Laboratory surveillance || SLAB
|-
| Extension activities || TL
|}

====Summary: Messages recommended for use in an important disease response====
* [[Operational instructions:CUL|CUL: Cull report/Culling]]
* [[Operational instructions:SLAB|SLABː Laboratory Surveillance/Surveilans Labatorium]]
* [[Operational instructions:SLAP|SLAPː Surveilans Lapangan]]
* [[Operational instructions:VAK|VAK: Vaksinasi]]
* [[Operational instructions:OB|OB: Pengobatan]]
* [[Operational instructions:TL|TL: Extension activities/Tindakan Lain]]

===Formulir 2 - Response===

These guidelines are to help report different disease response activities by SMS. The response activities required for different diseases may be different so not all the activities listed may be required.

[[File:PDI_FORM_2_RESPON.png|100px|thumb|left]]

This form is for use as a guide only for a Dr Hewan during field activities organised in an important disease response:  (a disease on the national priority list, a disease with high mortality or morbidity, zoonotic involvement, unusual signs, or suspected of being a new or emerging disease). All data should be submitted immediately as it is collected by SMS to iSIKHNAS using the formats described in this form. This form should be used as a worksheet to help SMS submission – do not submit this form.

In order to conduct a priority disease investigation and response activities using this form, staff will need to be sure of the case ID and the location code of the locale where the case is situated '''prior''' to going to the field for the investigation.  All SMS messages sent during any priority disease investigation will require the case ID which is automatically created by iSIKHNAS as soon as a U or a P disease report is sent from the field.  You will also require the Program IDs for activities such as culling extension, vaccination, and surveillance (Lab and Field based).

Note these down on the form to help you because you may need them for several messages connected with this response report.

====Culling====

[[File:PDI_form_2_culling.png|800px|centre]]

Report any animals that have been culled as part of an organised disease response activity. Separate reports should be sent for each day and village.

 {{#apGetSMSFormat:cul|1}}

*ID program: get this from you LDCC or iSIKHNAS coordinator
*Kode spesies:  to get a list of species code use 
 KODE SP
*Kode lokasi: use cari kode lokasi 
{{#apGetSMSFormat:ckl|1}}

====Surveilans====

[[File:PDI_form_2_surveilans.png|800px|centre]]

There are two ways of reporting surveillance, depending on the type of test used:

=====Field based surveillance=====

[[File:PDI_form_2_SLAP.png|600px|centre]]

This is used for surveillance that produces a result in the field. Normally this is either clinical surveillance or testing with a rapid test.
{{#apGetSMSFormat:slap|1}}

*ID program: get this from you LDCC or iSIKHNAS coordinator
*Spesies: to get a list of species code use
 KODE SP
*Lokasi: use cari kode lokasi 
{{#apGetSMSFormat:ckl|1}}

=====Surveilans laboratorium=====

[[File:PDI_form_2_SLAB.png|500px|centre]]

This is used for surveillance using laboratory tests. Specimens are collected in the field and sent to a laboratory for testing.

 {{#apGetSMSFormat:slab|1}}

*ID laboratorium: this is the 6 digit laboratory code. Gunakan daftar kode infrastruktur 
 DKI LAB {kode lokasi}

====Vaksinasi====

[[File:PDI_FORM_2_VAKSINASI.png|800px|centre]]

This is used for organised vaccination activity in response to a disease outbreak. Separate reports should be sent for each day and village.

 {{#apGetSMSFormat:vak|1}}

*ID program: get this from you LDCC or iSIKHNAS coordinator

====Other extension activities====

[[File:PDI_FORM_2_TINDAKAN_LAIN.png|800px|centre]]

This is used for other activities, such as KIE, disinfection etc.

 {{#apGetSMSFormat:tl|1}}

*ID program: get this from you LDCC or iSIKHNAS coordinator
*Kode jenis tindaka: use 
 KODE TL
*Lokasi: use cari kode lokasi 
{{#apGetSMSFormat:ckl|1}}

====Treatments====

[[File:PDI_FORM_2_PENGOBATAN.png|800px|centre]]

If animals are treated, record this with the following message

 {{#apGetSMSFormat:ob|1}}

*ID kasus: get this from the original alert report, or use laporan desa
{{#apGetSMSFormat:lapd|1}}
*Kode obat: use cari kode obat 
{{#apGetSMSFormat:cko|1}}